Chicago — Patients seeking upper-face rejuvenation have never before enjoyed as many safe, effective alternatives as are now available, says Kenneth Beer, M.D., director, Palm Beach Esthetic Institute, and clinical instructor of dermatology, University of Miami, Miami.
"Rejuvenation of the upper face is just now entering a renaissance," he says. "Five years ago, all we had was collagen and Botox (botulinum toxin A, Allergan). Now we have another toxin about to be released. The filler world has expanded exponentially. We also have threads such as the Threadlift. And for the first time in history, the lasers actually do what they're supposed to do."
Dr. Beer says he is particularly excited about trying new fractional-beam capabilities for skin tightening soon to be added to the StarLux line."Other companies including Reliant, Lumenis and Syneron also have exciting products," he says. Simultaneously, Dr. Beer says, cosmeceuticals are "living up to half their hype, which is twice what we expect. So it's a great time to look at rejuvenation for the upper face."
For starters, existing options are expanding their scope.
"It used to be said that the only place to inject botulinum toxin was the glabella or frown line. Now, not only are we doing forehead treatments, but we're also doing browlifts and sculpting. Treatments for crow's feet and lower eyelids are pretty standard. Treating the nasalis or bunny lines also is commonplace," he says.
Reloxin (botulinum toxin A, Inamed), now in phase 3 clinical trials, will increase the armamentarium, Dr. Beer adds.
In the filler category, he says, "We used to have just collagen. That wasn't too great for a variety of reasons. But now we have Sculptra (poly-L-lactic acid, Sanofi-Aventis/Dermik), Restylane (hyaluronic acid, Q-Med Laboratories), Radiesse (calcium hydroxyapatite, BioForm Medical). Juvederm (hyaluronic acid, Inamed) is around the corner, as is Perlane (Q-Med Laboratories). Hylaform Plus (Inamed) is available. Silicone is back, at least in some practices. So the materials that we have for upper face rejuvenation have increased exponentially."
With this expansion of options, Dr. Beer says, "I'm doing things now that two or three years ago I wouldn't have considered. I routinely inject soft tissue augmentation when I do botulinum toxin injections into the glabella to get a really smooth area. I inject into the tear trough of the lower eyelid, particularly with Restylane and Sculptra. And I inject the upper zygomatic arch with Radiesse, Restylane and Sculptra to get a little bit of an upper-face and midface lift."
He says he also uses the preceding three materials to treat temporal atrophy.
"When I'm doing browlifts with Botox," he adds, "I'll put a little bit of a filler right into the brow. And I still use some of the soft fillers like CosmoDerm (collagen, Inamed) or Hylaform for forehead wrinkles and crow's feet. There's just so much available now."
As for technique tips, Dr. Beer says, "inject very slowly and avoid any vasculature. When I teach people, I tell them to inject in a very cautious fashion and to take their time. I also try to ensure that the right filler goes into the right plane. By that I mean if one is using a filler such as CosmoDerm, which is designed for the superficial dermis, one must put it there. If one puts it deeply, the patient will waste their time and money."
Conversely, he says that if one injects Sculptra into the superficial dermis rather than the deep dermis where it belongs, patients will end up with bumps.
"Technique and knowledge of the different products is critical," he says.
Refusing to oversell products or procedures also is crucial, Dr. Beer adds.